Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-04T11:25:57.629Z Has data issue: false hasContentIssue false

Contribution of life events to causation of psychiatric illness

Published online by Cambridge University Press:  09 July 2009

E. S. Paykel*
Affiliation:
St George's Hospital Medical School, London
*
1Address for correspondence: Professor E. S. Paykel, St George's Hospital Medical School, Blackshaw Rd, London SW17.

Synopsis

This paper discusses the magnitude of the effect of life events in the causation of psychiatric illness. It is argued that an established epidemiological concept, relative risk, provides a useful measure of association which can be approximately adapted for retrospective controlled studies. Examination of studies employing general population controls consistently indicates effects of some importance, with risks of illness increased by factors of between 2 and 7 in the 6 months after an event. Risks are greater for the more stressful types of events, greater for depression and neuroses than schizophrenia, and even greater for suicide attempts. However, similar events occur commonly and a large proportion of event occurrences are not followed by illness. Events must interact with a wide variety of background factors, and the appropriate model is one of multifactorial causation.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1978

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Birtchnell, J. (1970). Recent parent death and mental illness. British Journal of Psychiatry 116, 282297.Google ScholarPubMed
Brown, G. W. (1975). Meaning, causality and reactive disorders. Paper presented at World Psychiatric Association Symposium on Social Causes of Psychiatric Disorders, Opatija, Yugoslavia.Google Scholar
Brown, G. W. & Birley, J. L. T. (1968). Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behaviour 9, 203214.CrossRefGoogle ScholarPubMed
Brown, G. W., Harris, T. O. & Peto, J. (1973 a). Life events and psychiatric disorders. Part 2: nature of causal link. Psychological Medicine 3, 159176.CrossRefGoogle Scholar
Brown, G. W., Sklair, F., Harris, T. O. & Birley, J. L. T. (1973 b). Life events and psychiatric disorders. Part 1: some methodological issues. Psychological Medicine 3, 7487.CrossRefGoogle Scholar
Brown, G. W., Ní Bhrolchaín, M. & Harris, T. O. (1975). Social class and psychiatric disturbance among women in an urban population. Sociology 9, 225254.CrossRefGoogle Scholar
Cadoret, R. J., Winokur, G., Dorzab, J. & Baker, M. (1972). Depressive disease: life events and onset of illness. Archives of General Psychiatry 26, 133136.CrossRefGoogle ScholarPubMed
Clayton, P. J. (1974). Mortality and morbidity in the first year of widowhood. Archives of General Psychiatry 30, 747750.CrossRefGoogle ScholarPubMed
Clayton, P. J. (1975). The effect of living alone on bereavement symptoms. American Journal of Psychiatry 132, 133137.Google ScholarPubMed
Cooper, B. & Sylph, J. (1973). Life events and the onset of neurotic illness: an investigation in general practice. Psychological Medicine 3, 421435.CrossRefGoogle ScholarPubMed
Doll, R. & Hill, A. B. (1964). Mortality in relation to smoking: ten years' observations of British doctors. British Medical Journal i, 13991410 and 1460–1467.CrossRefGoogle Scholar
Everitt, B. (1977). The Analysis of Contingency Tables. Chapman and Hall: London.CrossRefGoogle Scholar
Helgason, T. (1961). Frequency of depressive states within geographically delimited population groups. 4. The frequency of depressive states in Iceland compared with other Scandinavian countries. Acta Psychiatrica Scandinavica 37 (Suppl. 162), 8190.CrossRefGoogle Scholar
Jacobs, S. & Myers, J. (1976). Recent life events and acute schizophrenic psychosis: a controlled study. Journal of Nervous and Mental Disease 162, 7587.CrossRefGoogle ScholarPubMed
Jacobs, S., Prusoff, B. A. & Paykel, E. S. (1974). Recent life events in schizophrenia and depression. Psychological Medicine 4, 444453.CrossRefGoogle ScholarPubMed
Jaspers, K. (1923). General Psychopathology (trans. Hoenig, J. and Hamilton, M. W.). Manchester University Press.Google Scholar
Juel-Nielsen, N., Bille, M., Flygenring, J. & Helgason, T. (1961). Frequency of depressive states within geographically delimited population groups. 3: Incidence (The Aarhus County investigation). Acta Psychiatrica Scandinavica 37 (Suppl. 162), 6980.CrossRefGoogle Scholar
Kennedy, P., Kreitman, N. & Ovenstone, M. K. (1974). The prevalence of suicide and parasuicide (‘attempted suicide’). British Journal of Psychiatry 124, 3641.Google ScholarPubMed
Levi, L. O., Fales, C. H., Stein, M. & Sharp, V. H. (1966). Separation and attempted suicide. Archives of General Psychiatry 15, 158165.CrossRefGoogle Scholar
Maddison, D. & Walker, W. L. (1967). Factors affecting the outcome of conjugal bereavement. British Journal of Psychiatry 113, 10571067.CrossRefGoogle ScholarPubMed
McMahon, B. & Pugh, T. F. (1970). Epidemiology: Principles and Methods. Little, Brown and Co.: Boston.Google Scholar
Mechanic, D. (1976). Stress, illness and illness behaviour. Journal of Human Stress 2, 26.CrossRefGoogle Scholar
Myers, J. K., Lindenthal, J. J. & Pepper, M. P. (1971). Life events and psychiatric impairment. Journal of Nervous and Mental Disease 152, 149157.CrossRefGoogle ScholarPubMed
Parkes, C. M. (1964). Recent bereavement as a cause of mental illness. British Journal of Psychiatry 110, 198.CrossRefGoogle ScholarPubMed
Parkes, C. M. (1972). Bereavement. Studies of Grief in Adult Life. Tavistock: London.Google Scholar
Paykel, E. S. (1971). Classification of depressed patients: a cluster analysis derived grouping. British Journal of Psychiatry 118, 275288.CrossRefGoogle ScholarPubMed
Paykel, E. S. (1974). Recent life events and clinical depression. In Life Stress and Psychiatric Illness (ed. Gunderson, E. K. and Rahe, R. H.), pp. 134163. Charles C. Thomas: Springfield, III.Google Scholar
Paykel, E. S., Myers, J. K., Dienelt, M. N., Klerman, G. L., Lindenthal, J. J. & Pepper, M. P. (1969). Life events and depression: a controlled study. Archives of General Psychiatry 21, 753760.CrossRefGoogle ScholarPubMed
Paykel, E. S., Prusoff, B. A. & Myers, J. K. (1975). Suicide attempts and recent life events: a controlled comparison. Archives of General Psychiatry 32, 327333.CrossRefGoogle ScholarPubMed
Rahe, R. H. (1968). Life-change measurement as a predictor of illness. Proceedings of the Royal Society of Medicine 61, 11241128.CrossRefGoogle ScholarPubMed
Sørensen, A. & Strömgren, E. (1961). Frequency of depressive states within geographically delimited population groups. 2: Prevalence (The Samsø investigation). Acta Psychiatrica Scandinavica 37 (Suppl. 162), 6268.CrossRefGoogle ScholarPubMed
Thompson, K. C. & Hendrie, H. C. (1972). Environmental stress in primary depressive illness. Archives of General Psychiatry 26, 130132.CrossRefGoogle Scholar
Uhlenhuth, E. H. & Paykel, E. S. (1973). Symptom configuration and life events. Archives of General Psychiatry 28, 743748.Google ScholarPubMed
Uhlenhuth, E. H., Lipman, R. S., Balter, M. B. & Stern, M. (1974). Symptom intensity and life stress in the city. Archives of General Psychiatry 31, 759764.CrossRefGoogle ScholarPubMed
Wender, P. H. (1967). On necessary and sufficient conditions in psychiatric explanation. Archives of General Psychiatry 16, 4147.CrossRefGoogle ScholarPubMed
Wing, J. K., Mann, S. A., Leff, J. P. & Nixon, J. M. (1978). The concept of a ‘case’ in psychiatric population surveys. Psychological Medicine 8, 203217.CrossRefGoogle ScholarPubMed